Male Eating Disorder Management Using Cognitive-Behavioral Therapy (CBT) - Essay Example

Introduction

Eating disorders in men are a common problem often underdiagnosed due to the societal misconception of the disorder as a women's disease. Eating disorders have a significant impact on patient lives. These disorders include bulimia nervosa, anorexia nervosa, binge eating disorder, restrictive/ avoidant eating disorder, and symptoms of eating disorder (Sweeting et al., 2015; Sagha et al., 2019).

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A nurse leader advocates for the delivery of quality care to the patients in all aspects to improve outcomes. Nurse leadership is meant to ensure that care accorded to healthcare users is constantly evaluated and continuous guidance is given. The definition of clinical leadership in nursing care as provided by Joseph and Huber (2015) is “the process of influencing point-of-care innovation and improvement in both organizational processes and the individual care practices to achieve quality and safety of care outcomes.” Nurse leadership strives to achieve the right balance between individual principles, professional care guidelines, and the expectations of the patient and society (Pozgara, 2014). Nursing leadership in male eating disorders provides moral guidance on the delivery of intervention measures to the patients. Key strategic nursing leadership skills will be incorporated in achieving better outcomes using cognitive-behavioral therapy.

Cognitive-behavioral therapy (CBT)

Due to the disorders' mental health origin, the implementation of a psychological approach as the intervention is effective in promoting outcomes. The CBT intervention targets the psychopathology of the disease based on the trans-diagnostic theory (Murphy et al., 2010).

The management of eating disorders in adults with eating disorders who fit outpatient management is implemented using enhanced CBT. Challenges to achieving change in affected individuals such as reduced self-esteem, clinical perfectionism, and interpersonal conflicts are the enhancements added to CBT (Murphy et al., 2010).

There are two versions of the enhanced CBT for implementation in males with eating disorders in this discussion. The first one is the focused form of the enhanced CBT which aims at addressing the psychopathology of the disorder. It is the most suitable for most patients having eating disorders. The second version is the broad form of CBT that is aimed at addressing the external factors that inhibit change in addition to addressing the psychopathology of the disorders. This method is used mostly only in patient scenarios where there are pronounced obstacles to change (Murphy et al., 2010).

Murphy et al., (2010) indicate that in practice the enhanced CBT guides on having 20 sessions weekly for underweight patients in the first classification with a BMI of above 17.5. In patients with a BMI of less than 17.5 common in anorexia nervosa, the enhanced CBT guidelines require 4o weekly patient sessions. During this period of psychotherapy, the patient is assessed for the level of motivation to effect change, their feeding habits, and weight patterns.

The enhanced CBT will be implemented in the male patients in this discussion using a series of therapeutic procedures carried out in a sequence. The main goal is to achieve cognitive and behavioral change. The enhanced CBT applies the principle of collaborative empiricism where the therapist and the patient work together to set achievable targets and goals as opposed to the therapist dictating what is to be done. The main target of the enhancement is to achieve the use of to achieve change in thinking through strategic behavioral change (Murphy et al., 2010).

Stages of enhanced CBT for the management of eating disorders

At the start of implementing intervention strategies using enhanced CBT a thorough and collaborative clinical assessment is done to assess the nature and extent of the mental health disorder. This evaluation takes place in 2 or more sessions to ensure the patient is comfortable and ready for the initiation of treatment and change. These sessions are also aimed at motivating the patient to utilize all the resources available during the duration of the therapy to achieve maximum change. Factors that may hinder the effectiveness of the process are evaluated. The contraindication for the initiation of enhanced CBT is mapped out to avoid engaging the patient in the program yet no meaningful change will be achieved. These contraindications include the presence of drugs and substance abuse, commitment threatening the consistent adherence to the program, severe clinical depression, and major life distractions (Murphy et al., 2010).

Stage one

This stage takes 8 sessions held twice weekly aimed at achieving therapeutic momentum. The change achieved in the first stage is an important predictor of the overall patient outcomes.

Engaging patients in treatment and change

At this stage, most of the patients with eating disorders are usually unsure of the effective of the treatment and the possibility of change. The patient is assessed on the details of the eating disorder in an engagement that allows the patient to have hope about achieving change. The patient is also encouraged to take ownership and control of the treatment program (Murphy et al., 2016). In nursing, this step requires the engagement of an effective communication strategy the employs the use of simple understandable by the patient preventing the risk of misinterpretation (Kourkouta & Papathanasiou, 2014).

Creation of a treatment formulation in conjunction with the patient

In this step, the patient is guided using diagrams to understand the factors that facilitate the eating disorder. This patient is therefore able to use their own experience and words to develop a treatment program by realizing that the factor contributing to the disorder can be changed. The starting point is allowing the patient to identify something they wish to change and implement the set interventions (Murphy et al., 2016). This step encompasses the aspect of collaboration as indicated in Reinke and Hammer (2011) in ensuring a two-way solution finding to achieve positive results.

Real-time monitoring

In this step, the patient is required to maintain a real-time chart for self-evaluation of behavior, feelings, events, thoughts, and eating habits. This chart assists the therapist in monitoring progress and guiding the next course of action (Murphy et al., 2016). Patient self-monitoring is an effective cost-saving mechanism as it allows the patient to take charge of the treatment and reduce the length of treatment (Weissman & Rossell, 2017).

Collaborative weekly weighing

Weight measurements are done weekly during evaluation sessions to monitor progress and evaluate weight gain to avoid excessive body weight accumulation. The patient is discouraged from taking weight measurements in between the sessions (Murphy et al., 2016). Preventing excessive weight gain ensures patient safety is ensured as a core function of nursing leadership (Ayton & Ibrahim, 2018).

Health education

Progressively from stage one provision of health education to patients on eating and weight. Health education also helps address patient misconceptions about eating disorders. The session should target covering topics as features of eating disorders and their related psychical and psychosocial effects. Secondly, the patient is educated on body weight, body mass index (BMI), and treatments’’ effect on weight. Also, the health messages should emphasize on the ineffectiveness of weight control covert methods such as the use of vomiting and the use of laxatives or diuretics. These messages are essential in ensuring patient safety, improving the quality of care, and as a change management strategy (Murphy et al., 2016; John et al., 2019; Ayton & Ibrahim, 2018).

Establishing a regular eating pattern

Having an eating routine is effective in the management of all eating disorders and prevents bad eating habits such as binge eating. Development of a plan including meals and snacks within the course of the day that patients must adhere to and can be increased in amount over time in view of target weight gain. It is usually a challenge to adhere to the eating pattern but persistent psychological support coupled with patient behavioral changes provides benefits. In order to avoid the urge to break the routine or binge eating the patient may engage in distractive activities or move away from the environment that could lead to the temptation such as the kitchen. The patient may apply technology in adhering to the routine. As a leader patient education on the use of alarms and reminders and any available technology solutions is beneficial (Murphy et al., 2016).

Involving a significant others

Family member's and caretakers' support is beneficial in all mental health conditions and thus effective in eating disorders. In consideration of the male reluctance to accept the presence of a problem, this support will enable the patient to feel accepted and therefore is able to achieve change. Also, the support from significant others will help the patient adhere to the eating routine and provide financial support. The nurse leader in communication with the patient's family should focus on the need for patient support. Similarly, community support and involvement in stopping stigma improves patient psychological health thus better outcomes and increased presentation by men at early stages (Murphy et al., 2016).

Stage two

This is an assessment stage for the success, failures, and barriers experienced in stage one as the patient transitions to stage three. At this stage where the patient has shown improvement, they are appreciated and signify the effectiveness of the enhanced CBT, and where there are shortcomings the patient is educated and in severe cases enrolled for broad-based CBT. This stage only comprises of 2 assessment sessions for 2 weeks (Murphy et al, 2016).

Stage three

This is the main stage of treatment that is involved in addressing the process that contributes to psychopathology. This stage comprises 8 weekly appointments. This intervention addresses the patient's overvaluation of shape and weight, assessing and enlightening the patient on dietary routine. Additionally, in this stage the evaluation of how events change the patients’ eating habits, and the psychological factors affecting eating habits such as self-esteem and interpersonal conflicts (Murphy et al., 2016).

Stage four

This stage comprising 3 appointments 2 weeks apart entails the assessment outcome, setting a long-term term, and implanting strategies to prevent relapse of the eating disorder (Murphy et al., 2016).

References

Ayton, A., & Ibrahim, A. (2018). Does UK medical education provide doctors with sufficient skills and knowledge to manage patients with eating disorders safely? Postgraduate Medical Journal, 94(1113), 374-380. https://pmj.bmj.com/content/94/1113/374.abstract.

Johns, G., Taylor, B., John, A., & Tan, J. (2019). Current eating disorder healthcare services–the perspectives and experiences of individuals with eating disorders, their families, and health professionals: a systematic review and thematic synthesis. BJPsych Open, 5(4). https://www.cambridge.org/core/journals/bjpsych-open/article/current-eating-disorder-healthcare-services-the-perspectives-and-experiences-of-individuals-with-eating-disorders-their-families-and-health-professionals-systematic-review-and-thematic-synthesis/5EB2AD6BD8A971D6CB6CECC59EF23855

Joseph, M. & Huber, D. (2015). Clinical leadership development and education for nurses: prospects and opportunities. Journal of Healthcare Leadership, 2015(7), 55 – 64. doi: 10.2147/JHL.S68071